Hearing loss affects people of all ages, and it is conservatively estimated that at least 10% of any population have a hearing disorder. For a young child, early identification of hearing loss facilitates successful integration of that child into society as he or she grows up. The prevelance of hearing loss in the teenage population is steadily rising, due mainly to exposure to dangerous levels of environmental sounds, such as very loud music. Preventative awareness programs play a major role in controlling the number of teenagers affected. In the adult population, good hearing is important to maintaining an active and healthy lifestyle and for purposes of earning a living. As the life expectancy of people increases, and the number of elderly people increases, the negative impact of hearing loss on the quality of life during retirement years has become even more important.
Only about one percent of those with hearing loss seek diagnosis and intervention at an appropriate time. The main reason for this shortcoming is the lack of good information regarding options which are available, where to go for hearing tests, and where to purchase devices which will enable one to hear better. Even though many people have hearing aids, nearly all of those require ongong monitoring of the effectiveness of those devices, regular testing of the extent of hearing loss, and advice on how to make the best use of the hearing aid in order to maximize the benefit therof.
Typical audiometric tests of hearing are conducted in a relatively quiet room or in a sound proof booth. The health care professional uses an audiometer in the same room, or in an adjacent room with a two way mirror. The aim of the test is to determine the softest level (threshold) at which a sound/tone is heard. The testee is instructed to listen carefully and push a response button or raise their hand or finger each time they hear a sound/tone. A set of headphones is placed over the ears of the `testee`. The tester begins the test at a comfortable level at a mid frequency and continues the test at octaves from 250 Hz through 8000 Hz. The test is completed at each ear. The results are recorded on an audiogram. The above test may occassionally utilize speech materials; however, frequency specific information is not gleaned.
Early diagnosis of hearing loss is crucial for timely rehabilitation that could improve hearing and allow for improved quality of life for persons at all ages. Some forms of rehabilitation include amplification and assistive listening devices, medical intervention, support services and counselling. A large number of individuals, including children and the elderly, may suspect that they have a hearing loss albeit do not visit a health care center for a full scale evaluation and treatment. The reasons include expense, time, location, reticience, lack of awareness of options, lack of information about consequences of poor hearing, or procrastination. All clinically standard hearing tests to date depend on the expertise of a health care or of a hearing health care professional.
One particular problem of the standard audiometric test method is the reliance on specialized equipment at the site of testing. Over the last decade, a number of technological telecommunication advancements have allowed access to large groups of citizens; these include mobile phones and the internet. Through fixed and mobile internet connections, the internet provides a quick and easy means of reaching masses of the world population in private and retirement homes, schools, hospitals, clinics. In the last year, many health care services have been made available through the internet and end users are becoming more active participants in their health care.
One means of providing a great number of people with hearing health care services is to utilize the internet (fixed, mobile, via satellite or terresterial links). The present invention overcomes the restraints of time, distance, expense of initial hearing screening, and lack of access to vital information from the health care provider. To date, the developement of a hearing test over the internet has been hampered by the problems of sound calibration, i.e., when using the internet, there is no way of knowing the intensity level of the sound reaching the testee's eardrum. The present invention overcomes the obstacles listed above. Further, the invention provides a holistic approach to hearing health care, promotes awareness of hearing loss, and improves the quality of life for all citizens through a multi-lingual internet platform. The service is also accessible through licensed computer software.
The designation "HL" is an acronym for Hearing Level, and is used to refer to sound level measured above the softest level at which sound is heard (0 HL). The designation "SPL" is an acronym for Sound Pressure Level, and is a reference to the absolute value used by acousticians and scientists, and is typically measured with such as a sound level meter. The designation "SL" stands for Sensation Level, and is a reference to the level of decibels (dB) above Hearing Level. For example, if one's threshold for a 1000 Hz sound is 10 dB HL, then 20 SL would be 20 dB above your threshold, making the presentation level 30 dB HL. The presentation levels of the sounds as they are initially recorded is preferably set to 19 dB SL.
The major problem with any type of on-line testing, including testing of hearing through the Internet, is the difficulty with calibrating the sound output at the end users ear. Most testing in standard audiological test batteries depend on absolute calibration. Presentation levels and results are expressed in dB HL or dB SPL and the testing of threshold, i.e., the softest level at which a person hears a pure tone or speech sound. 0-20 dB HL is designated normal hearing across frequencies of 250, 500, 100, 2000, 4000, and 8000 Hz.
Presenting and recording hearing tests and screening over the internet presents difficulties for absolute calibration of signals. Furthermore, the signal can be affected by many variables including computer and internet transmission lines, and transducers used (e.g., headphones or loudspeakers). Threshold testing therefore presents enormous difficulties when used in the orthodox fashion.
The consumer logs onto a website capable of testing in accordance with the present invention, and the consumer is presented with a user-friendly screen in their choice of language, e.g., French, English, Italian, Spanish, Portuguese. The Screening of Hearing link is selected. Simple overview, instructions and requirements for the test (see appendix) are provided, including a hearing screening questionnaire about their health (general and hearing). They use a set of computer headphones (preferably circumaural). A trial run of the testing is available to demonstrate the test sequence and required response from the testee.
The actual testing commences one ear at a time. At the end of the test, the results are clearly outlined, i.e., the testee has either passed the hearing screening, or has failed the hearing screening. The testee can access the nearest hearing health center/clinic for a followup test through on line scheduling of an appointment. They have immediate access to the results of their tests and can be linked to their nearest, local or international health care centers/providers. Their results are logged into an International database. They are also provided with on-line access to information on hearing, hearing loss, rehabilitation, amplification, access to hearing related products and services, and to support systems globally. The test of hearing is provided through an adaptive test on-line or off-line through licensed software.
In the present invention, the problems encountered by previous attempts to test and screen hearing in terms of absolute and threshold levels is avoided. The invention relies on suprathreshold measures to screen hearing, rather than on absolute threshold measures. In this manner the test is self-calibrating. The test methodology of the present invention uses presentation levels above threshold, and relies on established and validated physiological attributes of the hearing mechanism and normative data for normal and abnormal hearing. The invention focuses on the individual's ability to differentiate small differences in intensity, duration and frequency levels.
One of the tests performed with the system of the present invention recognizes that persons with normal hearing may not be able to detect small differences between otherwise similar sounds, e.g., a short duration 1 dB increase in intensity; whereas, those with sensorineural hearing losses will be able to detect the differences. The present invention presents a plurality of sounds, at comfortable levels, which can be heard by persons with sensorineural hearing losses, but which cannot be heard by persons without such losses. Similarly, a person with normal hearing may be able to detect the difference between a plurality of bursts one of which is slighly longer (or shorter) in duration than the others, whereas a person with a hearing loss or who otherwise has a hearing problem, may not be able to detect such a difference. Finally, a person with normal hearing may be able to detect the difference between a plurality of tones one of which has a frequency which slightly higher or lower that the others, whereas a person with a hearing loss or who otherwise has a hearing problem, may not be able to detect such a difference.